Dr Erika Duffell

1
Dr Erika Duffell Siobhan Fahey Greater
Manchester Hepatitis C Strategy Group
2
Background to the development of the strategy in
Greater Manchester

• Local concerns following the publication of
  national Hepatitis C Strategy and Action Plan
  alongside data from Unlinked Anonymous Prevalence
  Monitoring Programme (UAPMP) indicating that the
  prevalence of hepatitis C in drug users in
  Greater Manchester was among highest in UK
• This led to a discussion paper to local Directors
  of Public Health in May 2005 to support the
  formation of a strategy group to enable a
  coordinated local approach to hepatitis C in line
  with national guidance and local need
• Greater Manchester Hepatitis C Strategy Group
  formed in 2005
• Multi-agency group comprising of individuals from
  public health, clinical and laboratory services,
  commissioners, HPA, drug services, NTA, primary
  care, University of Manchester, Needle exchange,
  etc.

3
Health Needs Assessment

• A health needs assessment was undertaken which
  found evidence of high prevalence of disease,
  escalating demand on local treatment and testing
  services and deficiencies around local prevention
  of blood borne viruses
• Local epidemiological modelling estimated
  prevalence of hepatitis C to be around 20,000
• Based on this work a comprehensive, costed
  strategy for tackling hepatitis C was produced by
  the Strategy Group
• Local Directors of Public Health, Finance and
  Commissioning were lobbied for resources
• Funding was secured to escalate local testing,
  treatment and prevention services across the 10
  PCTs
• A manager was appointed by the group to implement
  the strategy

4
Greater Manchester Hepatitis C Strategy

5
Organisational structure of Greater Manchester
Hepatitis C Strategy
6
Implementation of the Greater Manchester
Hepatitis C Strategy

• Progress around treatment
• Increase in numbers treated by over 100
• Increase in treatment locations to include range
  of secondary care and community locations
• Increased Consultant and Specialist Hepatitis C
  Nurse time
• Drug procurement project with pharmaceutical
  companies to reduce drug costs across 10 PCTs
• Development of locally agreed hepatitis C
  treatment guidelines by clinicians
• Project in development to evaluate treatment
  provision in primary care

7
Implementation of the Greater Manchester
Hepatitis C Strategy

• Progress around testing
• Development of dry blood spot testing methodology
  for hepatitis C testing by local laboratory
• Training of local drug workers trained around
  hepatitis and the use of dry blood spot testing.
  Training course evaluated by University of
  Manchester.
• Primary care pilot of testing in progress
• Development of testing protocols for
  dissemination
• Work with primary care to increase testing of at
  risk groups

8
Implementation of the Greater Manchester
Hepatitis C Strategy

• Progress around Research and Workforce
  Development
• Development of Blood Borne Virus Research Team
  (BBVRT) at the University of Manchester supported
  through resources from strategy
• Work undertaken by BBVRT includes
• Mapping of local professionals training needs in
  relation to hepatitis C
• Greater Manchester Hepatitis C Health Care Needs
  Assessment of prevention services
• Health Equity Audit of hepatitis C services
• Community Development Worker employed to engage
  with patients and develop patient forums
• Establishment of regular research forums

9
Implementation of the Greater Manchester
Hepatitis C Strategy

• Progress around communications
• Development of a communication strategy for
  hepatitis C based using social marketing research
  
• Key objectives of the strategy are to underpin
  work of the strategy group and increase awareness
  among targeted audiences
• Employment of part-time communications officer
• Strategy includes work with DoH communications
  campaign focusing on increasing awareness among
  culturally diverse groups
• Evaluation of key aspects of communication
  strategy

10
Implementation of the Greater Manchester
Hepatitis C Strategy

• Progress around prevention
• Establishment of a multi-agency blood borne virus
  prevention network
• Development of a blood borne virus prevention
  strategy across Greater Manchester based on the
  results of the health care needs assessment
• Aim of strategy is to improve primary and
  secondary prevention initiatives to guard against
  blood borne virus infections focusing around the
  following key areas
• Needle and syringe programmes
• Targeted harm reduction measures
• Training of local staff
• HBV vaccination

11
Implementation of the Greater Manchester
Hepatitis C Strategy

• Progress around prisons
• Development of a prison strategy to improve blood
  borne virus prevention services and increase
  number of prisoners being tested and treated for
  hepatitis C
• Employment of dedicated specialist hepatitis C
  nurse to provide care across all local prisons
• Increased consultant in-reach time
• Action research around testing of prisoners

12
Greater Manchester Hepatitis C Strategy Service
Redesign Project

• Key members of the Strategy Group are now engaged
  in a one year project with local commissioners to
  further develop hepatitis C services (testing,
  treatment and post-treatment)
• The key aims of the project are to
• map current care pathway around hepatitis C care
  and develop future pathway
• undertake gap analysis and identify opportunities
  for service development
• undertake modelling of epidemiology and costs
• develop detailed service specifications
• develop a local tariff for hepatitis C care

13
Greater Manchester Hepatitis C Strategy the
future

• Further expansion in treatment and testing
  services
• Continuation of the communications campaign
• Implementation of multi-agency prevention
  strategy
• Further research around hepatitis C which will
  help the strategy develop including
• Projects to explore HCV awareness and prevalence
  in local MSM population
• Enhanced case finding study
• Project around non attendees at NHS centres

14
Greater Manchester Hepatitis C Strategy
supporting factors and potential threats

• Supporting factors
• High local prevalence of hepatitis C
• Tight geographical area
• Local commissioning patterns
• Dedicated local professionals
• Support from public health
• Programme manager
• Potential threats
• Individual commissioning by PCT
• NHS financial situation

15
Acknowledgements

• To Siobhan Fahey and all members of the
• Greater Manchester Hepatitis C Strategy
• Group, subgroups, Service Re-design Project,
• University of Manchester Blood Borne Virus
• Research Team and the Association of
• Greater Manchester PCTs.